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. 2022 Sep 20;11(18):e7743.
doi: 10.1161/JAHA.122.027094. Epub 2022 Sep 14.

Enriching the American Heart Association COVID-19 Cardiovascular Disease Registry Through Linkage With External Data Sources: Rationale and Design

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Enriching the American Heart Association COVID-19 Cardiovascular Disease Registry Through Linkage With External Data Sources: Rationale and Design

Andrew S Oseran et al. J Am Heart Assoc. .

Abstract

Background The AHA Registry (American Heart Association COVID-19 Cardiovascular Disease Registry) captures detailed information on hospitalized patients with COVID-19. The registry, however, does not capture information on social determinants of health or long-term outcomes. Here we describe the linkage of the AHA Registry with external data sources, including fee-for-service (FFS) Medicare claims, to fill these gaps and assess the representativeness of linked registry patients to the broader Medicare FFS population hospitalized with COVID-19. Methods and Results We linked AHA Registry records of adults ≥65 years from March 2020 to September 2021 with Medicare FFS claims using a deterministic linkage algorithm and with the American Hospital Association Annual Survey, Rural Urban Commuting Area codes, and the Social Vulnerability Index using hospital and geographic identifiers. We compared linked individuals with unlinked FFS beneficiaries hospitalized with COVID-19 to assess the representativeness of the AHA Registry. A total of 10 010 (47.0%) records in the AHA Registry were successfully linked to FFS Medicare claims. Linked and unlinked FFS beneficiaries were similar with respect to mean age (78.1 versus 77.9, absolute standardized difference [ASD] 0.03); female sex (48.3% versus 50.2%, ASD 0.04); Black race (15.1% versus 12.0%, ASD 0.09); dual-eligibility status (26.1% versus 23.2%, ASD 0.07); and comorbidity burden. Linked patients were more likely to live in the northeastern United States (35.7% versus 18.2%, ASD 0.40) and urban/metropolitan areas (83.9% versus 76.8%, ASD 0.18). There were also differences in hospital-level characteristics between cohorts. However, in-hospital outcomes were similar (mortality, 23.3% versus 20.1%, ASD 0.08; home discharge, 45.5% versus 50.7%, ASD 0.10; skilled nursing facility discharge, 24.4% versus 22.2%, ASD 0.05). Conclusions Linkage of the AHA Registry with external data sources such as Medicare FFS claims creates a unique and generalizable resource to evaluate long-term health outcomes after COVID-19 hospitalization.

Keywords: COVID‐19; cardiovascular diseases; fee‐for‐service; medicare; mortality; postdischarge outcomes; readmissions.

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Figures

Figure 1
Figure 1. American Hospital Association COVID‐19 Registry linkage data sets.
The American Hospital Association (AHA) COVID‐19 Registry was linked to: (1) a 100% sample of Medicare fee‐for‐service claims, which includes demographic information (Medicare Beneficiary Summary Files), hospitalization information (inpatient fee‐for‐service claims), and historical comorbidity burden (Chronic Conditions Segment); (2) the Social Vulnerability Index, which provides a county‐level rank/score of a community's social vulnerability based on socioeconomic status, household composition and disability, minority status and language, housing type, and transportation; (3) Rural–Urban Commuting Area Codes, which categorize an individual's residence as urban (metropolitan and micropolitan) or rural based on ZIP code; and (4) American Hospital Association Survey, which provides hospital‐level characteristics. FFS indicates fee‐for‐service.
Figure 2
Figure 2. Flow chart: linkage of American Hospital Association COVID‐19 Registry and fee‐for‐service Medicare COVID‐19 admissions.
AHA indicates American Heart Association; FFS, fee‐for‐service; ICD‐10, International Classification of Diseases, Tenth Revision; and VA, Veterans Administration.
Figure 3
Figure 3. Balance of patient, community, and hospital characteristics and in‐hospital outcomes among linked American Hospital Association Registry‐Medicare fee‐for‐service patients and unlinked Medicare fee‐for‐service patients with COVID‐19 hospitalization.
Absolute standardized difference is calculated by taking the difference in means of a covariate across treatment groups, divided by the combined SD of both groups. Multivariate Mahalanobis distance was used for multinomial variables. ICU indicates intensive care unit; RUCA, Rural–Urban Commuting Area codes; SVI, Social Vulnerability Index; and TIA, transient ischemic attack.

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